Provider Demographics
NPI:1518469253
Name:ALEXANDER, MONICA L (LMT, LE)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:ALEXANDER-FROESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-0573
Mailing Address - Country:US
Mailing Address - Phone:313-398-0153
Mailing Address - Fax:
Practice Address - Street 1:9811 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1930
Practice Address - Country:US
Practice Address - Phone:313-398-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist